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Evaluation of 30-day mortality for 500 patients undergoing non-emergency surgery in a COVID-19 cold site within a multicentre regional surgical network during the COVID-19 pandemic

By Veeru Kasivisvanathan, Jamie Lindsay, Sara Rakhshani-moghadam, Ahmed Elhamshary, Konstantinos Kapriniotis, Georgios Kazantzis, Bilal Syed, John Hines, Axel Bex, Daniel Heffernan Ho, Martin Hayward, Chetan Bhan, Nicola MacDonald, Simon Clarke, David Walker, Geoff Bellingan, James Moore, Jennifer Rohn, Asif Muneer, Lois Roberts, Fares Haddad, John D. Kelly

Posted 12 Jun 2020
medRxiv DOI: 10.1101/2020.06.10.20115543

Background Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems. Objective To determine whether it is feasible and safe to continue non-emergency surgery in the COVID-19 pandemic Design, setting and participants This is a cohort study of 500 consecutive patients undergoing non-emergency surgery in a dedicated COVID-19 cold site following the first case of COVID-19 that was reported in the institution. The study was carried out during the peak of the pandemic in the United Kingdom, which currently has one of the highest number of cases and deaths from COVID-19 globally. We set up a hub-and-spoke surgical network amongst 14 National Health Service institutions during the pandemic. The hub was a cancer centre, which was converted into a COVID-19 cold site, performing urological, thoracic, gynaecological and general surgical operations. Outcomes The primary outcome was 30-day mortality from COVID-19. Secondary outcomes included all-cause mortality and post-operative complications at 30-days. Results 500 patients underwent surgery with median age 62.5 (IQR 51-71). 65% were male and 60% had a known diagnosis of cancer. 44% of surgeries were performed with robotic or laparoscopic assistance and 61% were considered complex or major operations. None of the 500 patients undergoing surgery died from COVID-19 at 30-days. 30-day all-cause mortality was 3/500 (1%). 10 (2%) patients were diagnosed with COVID-19, 4 (1%) with confirmed laboratory diagnosis and 6 (1%) with probable COVID-19. 33/500 (7%) of patients developed Clavien-Dindo grade 3 or higher complications, with 1/33 (3%) occurring in a patient with COVID-19. Conclusion It is safe to continue non-emergency surgery during the COVID-19 pandemic with appropriate service reconfiguration.

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